The Author and his beliefs

Atul Gawande is an American medical doctor, the son of two doctors who immigrated to the U.S. from India. He was raised nominally Hindu, but by his own admission he is functionally secular and non-religious, and the focus of his book is not at all on giving hope beyond this life, only on dealing with the death from a clinical perspective.

However, I would argue that whatever you believe about the future invariably affects the way you interpret the meaning and purpose of life, as well as how you cope with mortality, and this does come through in some of his conclusions.

Content and Highlights

The book begins with a description of physical changes that happen as people age, beginning at age 35.

Dying Well

Next, Atul Gawande gives a brief history of nursing homes. I found this part very interesting. About 50% of Americans die in nursing homes. Some might say this is very sad, which in some ways it is – however, understanding the way that most people died in the past makes you see that this is actually a great improvement over 100 years ago, when many people died in state-funded “poor houses” which even at their best had awful conditions.

He then goes on to describe the development of “assisted living” facilities, and how many have now deviated from their original purpose and design. He also tells stories of people who have sought to improve these facilities through innovation, such as bringing living things, e.g. plants, animals and children into these homes to improve residents’ quality of life.

While the author does say that the older model of a multi-generational home in which elderly people are cared for at home until they die has some benefits, he also shows its limits and downsides, using his own grandfather as an example.

Palliative Care

Atul also describes the benefits of palliative care for elderly people, which is focused on improving a person’s quality of life rather than on invasive treatments which may reduce a dying person’s quality of life even though they have little to no chance of curing them or significantly prolonging their life.

Even though palliative care has been shown to help improve and often prolong a person’s life, one of the sad things Gawande points out is that many insurance providers have stopped paying for palliative care, but they continue paying for invasive treatments, even if they are unnecessary or unhelpful to patients. This perpetuates a cycle of doing everything possible for patients, even if those treatments are not likely to lengthen their life and will probably make their quality of life worse.

The Big Point

Atul Gawande’s main point is summed up in this statement:

“Over and over, we in medicine inflict deep gouges at the end of people’s lives and then stand oblivious to the harm done.”

He argues that as people live longer and more die of old age, we should be focused on helping people stay in control of their lives as long as possible, achieve their goals, and die with dignity.

A Reason for Living

It is impossible to talk about dying without some sort of existential discussion about what gives life meaning and purpose.

At one point, Atul Gawande references the Harvard philosopher Josiah Royce, who said that “simply existing – merely being housed and fed and safe and alive – seems empty and meaningless to us.” He goes on to explain that we all seek a cause beyond ourselves, and it is in ascribing value to the cause and seeing it as worth sacrificing for, that gives our lives meaning.

Royce said that this reason for living was the opposite of individualism. An individualist puts self-interest first, seeing his or her own pain, pleasure and existence as their greatest concern. For the individualist, self-sacrifice makes no sense, but since their own self is the highest cause for which they live, their life has no meaning other than to make themselves happy. Ironically, it is for this reason that happiness and satisfaction will always elude them. For the individualist death is meaningless and ultimately terrifying.

It is for this reason, Gawande explains, that we all need something beyond ourselves and outside of ourselves to live for, and this is why elderly people who have pets, for example, tend to live longer lives.

The problem with Gawande’s search for meaning

The problem with Gawande’s search for meaning, is that he has identified a real need, and yet he basically says in the end that since he doesn’t believe there is anything beyond this life, therefore it is better to give someone the illusion that their life has meaning and purpose and value beyond themselves, even though no such thing really exists.

He does mention that people want their lives to make a difference after they are gone, but what he fails to answer is: to what end? Why should anyone care about what happens after they are gone, if life is actually meaningless, and after this light burns out there is only darkness? From this same logic, a totally selfish existentialism could also be argued for – such as that of the Epicureans: “Let us eat and drink, for tomorrow we die!” – in other words #YOLO – since we only live once, who cares what destruction we leave in our wake for others to deal with?! It’ll be their problem, not ours!

The solution which only the gospel gives

In this search for meaning and purpose, I would argue that it is only the gospel message of Jesus Christ which gives a satisfactory answer to humankind’s search for meaning and hope beyond this life.

It is only the gospel which gives us real hope beyond this life, and a real mission in this life which has more than just illusionary results. In the gospel we have hope for life beyond this one, and the effects of our mission are eternal in nature.

As CS Lewis put it at the end of the Chronicles of Narnia:

“For us, this is the end of all the stories…but for them it was only the beginning of the real story. All their life in this world and all their adventures in Narnia had only been the cover and the title page: now at last they were beginning Chapter One of the Great Story which no one on earth has read: which goes on for ever: in which every chapter is better than the one before.” – CS Lewis, The Last Battle

In order to truly “die well”, what we need is not just dignity, but HOPE. And this is found only and ultimately in the gospel message of Jesus Christ.

Should you read it?

I would recommend Atul Gawande’s Being Mortal. It was full of important thoughts about the process of dying in Western society today. However, I recommend reading the book with an eye to its one glaring shortcoming: it fails to address the need for and the source of HOPE both for this life and the one to come.